uMshwathi MUNICIPALITY · 2016-10-11 · 00205 Demolition services 00424 Locksmith services 00206...

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uMshwathi MUNICIPALITY

Application for Listing on

Accredited Suppliers Database

Completed and clearly marked registration form together with all the relevant

supporting documents must be submitted to

SUPPLY CHAIN MANAGEMENT UNIT

uMshwathi Municipality

Private Bag x29, Wartburg, 3233

or

Hand delivered to our offices in

New Hanover, Main Road

Opposite police station

3440

Faxed Application forms will not be considered

For further information please telephone the Supply Chain Management Unit

on 033 815 2249 or email [email protected]

This form is also available on the Municipality’s website at

Http://www.uMshwathi.gov.za

http://www.umshwathi.gov.za/

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___________________________________________________________________

Registration on data base in terms of:

1. Preferential Procurement Policy Framework Act No. 5 of 2000.

2. Preferential Procurement Regulations (No. R.725 of 10 August 2001)

3. Local Government Municipal Finance Management Act No. 56 of 2003.

This form must be duly completed, with a black pen, signed as requested

and placed together with supporting documentation, in an envelope clearly

marked “Data Base of Prospective Suppliers” and forwarded to the Municipal

Manager, Private Bag X29, Wartburg, 3233, or handed in at the Municipal

Offices at New Hanover, Main Road, Opposite Police Station, 3440.

PLEASE NOTE

Registration on the uMshwathi Municipality Supplier Database does not

guarantee business opportunities with the Municipality.

All Supplier information will be treated strictly confidential.

Please keep copies of the application form and all documentation submitted for

your own records as no copies will be made by the uMshwathi Municipality.

This form is also available on the Municipality’s website at:

http://www.uMshwathi.gov.za

All alterations must be initialled by the applicant.

___________________________________________________________________

FOR OFFICIAL USE:

Business Name

Date Received

Accepted

Date Captured

Database Registration

Number

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Section 1: Personal / Business Information

Prof/Dr/Mr/Mrs/Ms

1.1 Title, Initials and Surname

(if one person concern) __________________________________

1.2 Identity number __________________________________

1.3 Business Trading Name

(must be reflected on invoices & will be

reflected on contracts/orders/ cheques)__________________________________

1.4 Business Registered Name ___________________________________

1.5 Company BBBEE Rating

(here applicable) ___________________________________

1.6 CIDB / PSIRA Certificates

(here applicable) ___________________________________

1.7 Physical Address ___________________________________

___________________________________

___________________________________

___________________________________

1.8 Postal Address ___________________________________

___________________________________

___________________________________

___________________________________

1.9 Ward number

(if within uMshwathi Municipality) ___________________________________

1.10 Telephone number (incl. code) ___________________________________

1.11 Fax number (incl. code) ___________________________________

1.12 Cell phone number ___________________________________

1.13 Website address ___________________________________

1.14 E-mail address ___________________________________

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Section 2: Type of Business (Tick appropriate Box with a X)

2.1 Close Corporation

2.4 Public Company (LTD)

2.3 Cooperative

2.7 Partnership

2.2 Private Company (PTY) Ltd.

2.5 Sole Proprietor / One Person Business

2.6 Trust

Section 2A: Describe briefly your business’s principal activities

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

Section 3: Business Details

3.1 Business Registration Number. _____________________________

3.2 Income Tax Registration Number _____________________________

3.3 VAT Registration Number _____________________________

3.4 UIF Registration Number _____________________________

3.5 uMshwathi Municipal Account Number/s _____________________________

(rates number, etc - where applicable)

3.6 Banking Details: Bank Name _____________________________

Branch Name _____________________________

Branch No. _____________________________

Account No. _____________________________

Account Type _____________________________

Name under which account is operated _____________________________

3.7 Number of years in business _____________________________

3.8 Annual turnover R___________________________

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Section 4. Business Type

Please indicate the nature of operations, products or services applicable to

your business by ticking the appropriate boxes with a X:

NB : YOU ARE ALLOWED A MAXIMUM OF FIVE TICKS (X) PER COMPANY.

CODE COMMODITY X CODE COMMODITY X

00100: CONSTRUCTION EQUIPMENT AND SUPPLIERS

00400: GENERAL SERVICES

00101 Air conditioning and temperature control equipment

00401 Accommodation and lodging

00102 Building equipment and accessories (cement mixers, scaffolding, trowels, levels, etc)

00402 Advertising, communication, design, editorial, publication and marketing services

00103 Building materials (bricks, cement, sand, painting, plastic, stone, steel, tiles, etc

00403 Auctioneering services

00104 Ceiling boards, skirting, etc 00404 Bookkeeping and accounting services

00105 Construction machinery 00405 Catering and refreshments

00106 Doors and windows 00406 Cleaning services

00107 Electrical systems, lighting, components accessories and suppliers

00407 Conferencing facilities and facilitation

00108 Flooring materials (Carpets, tiles, etc)

00408 Contract administration

00109 Glass 00409 Courier services

00110 Plumbing ware and materials 00410 Education and training

00111 Roofing materials 00411 Environmental impact studies

00112 Sanitation ware and equipment

00412 Freight forwarding and clearing services

OTHER SPECIFY 00413 General maintenance services

00414 General wholesale

00415 Health care

00416 Horticulture

00417 Infrastructural maintenance

00418 Inspection services

00200: CONSTRUCTION SERVICES

00419 Insurance

00201 Burglar proofing and system 00420 IT, broadcasting, telecommunication services

00202 Civil Engineering Structures 00421 Interior decorating, refurbishment and upholstery

00203 Concrete manufacture and works

00422 Land valuation

00204 Construction-related transport 00423 Laundry and dry-cleaning services

00205 Demolition services 00424 Locksmith services

00206 Earthworks, drilling and landscaping

00425 Mailing services

00207 Electrical installation 00426 Management services

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00208 Fencing 00427 Miscellaneous equipment and goods hiring

00209 General building works 00428 Personnel services

00210 Glazing 00429 Pest control and removal services

00211 Mechanical contracts 00430 Photographic and graphic design services

00212 Metalwork 00431 Picture framing

00213 Painting 00432 Printing

00214 Paving 00433 Procurement services

00215 Plumbing 00434 Real estate services

00216 Pre-cast concrete manufacture

00435 Research services

00217 Pump installation 00436 Security and safety services

00218 Roads works 00437 Site cleaning

00219 Sewerage systems and construction

00438 Social Facilitating

00220 Specialist Trade Contractors 00439 Storage

00221 Water works and pipelines 00440 Translation and interpreting services

OTHER SPECIFY 00441 Transport services, general

00442 Travel services

00443 Vehicle hire

00444 Vending services

OTHER SPECIFY

CODE COMMODITY X CODE COMMODITY X

00300: ELECTRICAL AND MECHENICAL EQUIPMENT, SERVICES AND SUPPLIES

00700: PROFESSIONAL SERVICES

00301 Bearing supplies 00701 Accounting, auditing and management services

00302 Bolts, nuts and fasteners 00702 Architectural services

00303 Electric cable 00703 Consulting Engineering: Electrical

00304 Electrical component supplies 00704 Consulting Engineering: Environmental

00305 Electrical equipment 00705 Consulting Engineering: Geo-technical

00306 Electrical equipment repairs 00706 Consulting Engineering: Mechanical

00307 Hardware supplies 00707 Consulting Engineering: other

00308 Lifting equipment 00708 Consulting Engineering: Project Management

00309 Mechanical seals and packing

00709 Consulting Engineering: Roads and storm water

00310 Pipe and irrigation supplies 00710 Consulting Engineering: Sewerage systems

00311 Power generation and distribution machinery and accessories

00711 Consulting Engineering: Solid waste

00312 Pump spares 00712 Consulting Engineering: Structures, buildings, bridges, etc

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00313 Small tools 00713 Consulting Engineering: Water systems

00314 Transformer services 00714 Engineering services

00315 Valves, couplings 00715 Financial services

00316 Water meter, pipes, fittings, galvanised PVC, uPVC, mPVC, polyethylene, etcetera

00716 Land surveying

OTHER SPECIFY 00717 Legal services – contracts

00718 Legal services – conveyance

00719 Legal services – litigation

00720 Legal services – other

00721 Medical services

00500: OFFICE AND FACILITATIES EQUIPMENT AND SUPPLIES

00722 Project Management

00501 Computer equipment, networks and software

00723 Quantity surveying

00502 Consumables 00724 Town and regional planning

00503 Corporate gifts OTHER SPECIFY

00504 Domestic, industrial and cleaning equipment and supplies

00505 Electronic equipment, including audio-visual equipment

00506 Fire protection equipment

00507 Flowers and plants 00800: VEHICLE SUPPLY AND TRANSFORMATION SERVICES

00508 Food and refreshments 00801 Alarm and tracking systems

00509 Household furniture and equipment

00802 Auto electrical repairs

00510 Office furniture and equipment

00803 Batteries

00511 Office supplies and stationery 00804 Engine overhauls

00512 Printing, copying and photographic equipment and supplies

00805 Fuel, oils and lubrications

00806 Hydraulics

00600: MISCELLANEOUS GOODS AND SUPPLIES

00807 Panel beating

00601 Environmental cleansing equipment, goods and supplies

00808 Radio repairs

00602 Fire protection equipment, goods and supplies

00809 Radio and electronic equipment

00603 Garden tools 00810 Spares and parts

00604 Gas 00811 Towing services

00605 Laboratory chemical 00812 Transmissions

00606 Materials and warehousing machinery, equipment and goods

00813 Tyres and tubes

00607 Measuring, testing and observation equipment

00814 Upholstery

00608 Pharmaceutical 00815 Vehicle fleet management

00609 Protective clothing and uniforms

00816 Vehicle supply

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00610 Security equipment, goods and services

00817 Windscreens

00611 Specialized imported chemicals

OTHER SPECIFY

00612 Sport and recreation equipment and goods

OTHER SPECIFY

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Section 5: List all Directors / Owners / Partners / Members

NAME ID NUMBER DATE RSA CITIZENSHIP OBTAINED

DATE/ POSITION OCCUPIED IN ENTERPRISE

% TIME DEVOTED TO ENTERPRISE

NO FRENCHISE PRIOR TO ELECTIONS

WOMEN DISABLED % OF BUSINESS/ ENTERPRISE OWNED

* Indicate Yes or No

“Historically Disadvantaged Individual (HDI)” means a South African citizen

(1) who, due to the apartheid policy that had been in place had no franchise in national elections prior to the introduction of the

Constitution of the Republic of South Africa, 1983 (Act No 110 of 1983) or the Constitution of the Republic of South Africa,

1993 (Act No 200 of 1993) (“the Interim Constitution”); and/or

(2) who is a female; and/or

(3) who has a disability;

provided that a person who obtained South African citizenship on or after the coming to effect of the Interim Constitution, is

deemed not to be an HDI.

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Section 6 : Employment Information:

6.1 How many full time and part time staff members do you employ?

Gender Historical Disadvantage Individuals

Other

Full Time Part Time Full Time Part Time

Male

Female

Section 7 : Supplier Profile

7.1 Are there any pending legal proceedings or previous judgements against your business or has your business ever been declared bankrupt: Yes / No

If yes, please elaborate: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 7.2 Is your business a permit holder under the SABS mark scheme?

Yes / No

If yes, indicate product(s) for which permits are held, including permit numbers ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 7.3 Does your business operate a Quality Management System covering the product / service you provide? Yes / No

If yes, please elaborate: ______________________________________________________________________________________ ______________________________________________________________________________________

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______________________________________________________________________________________ Does your business have an Occupational Health and Safety Policy complying with

the Occupational Health and Safety Act?

Yes / No

7.5 Are you registered with the Compensation for Occupational Injuries and

Diseases.

Act (COID)?

Yes / No.

If yes. provide COID Registration No: _____________________________________

7.6 Do you have Environmental Policy in place?

Yes / No

Section 8 : Disclosure of State / Municipal interests:

8.1 Please indicate whether you or a director, manager, principal shareholder of your

enterprise is/are or has/have been in the service of the State, the uMshwathi

Municipality or another Municipality in the previous twelve months. If YES, please

provide full details, in which capacity it was:

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

8.2 Please indicate whether your spouse, child, parent, brother or sister or the

spouse, child, parent, brother or sister of a director, manager, shareholder or

stakeholder of your enterprise is/are or has/have been in the service of the State, the

uMshwathi Municipality or another Municipality in the previous twelve months. If

YES, please provide details, including names, relationships and capacities:

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

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Section 9 : Declaration of Correctness of information provided:

I / We the undersigned, warrant that I am/we are duly authorised to do so and on behalf of

___________________________________________________________________

declare that:

1. That the information contained in this document is correct.

2. All copies of relevant documentation are attached.

3. The Historically Disadvantaged status of individuals as stated is correct and based

on owners/shareholders/partners actively involved in the day-to-day management of this

enterprise.

If the information supplied is found to be incorrect then the uMshwathi Municipality in

addition to any remedies, it may have; may

(i) recover from you/your enterprise all costs, losses or damages incurred or

sustained by the Municipality as a result of the award of the contract, and/or;

(ii) cancel the contract and claim any damages which the Municipality may suffer by

having to make favourable arrangements after such cancellations, and/or;

(iii) Impose a penalty as provided in the Tender Documents, and/or;

(iv) Take any other action as may be deemed necessary.

Signature ____________________ Signature ____________________

Name ____________________ Name ____________________

ID number ____________________ ID number ____________________

Capacity ____________________ Capacity ____________________

Telephone no ____________________ Telephone no ____________________

Date ____________________ Date ___________________

Address _____________________ Address ___________________

_____________________ ___________________

Commissioner of Oaths:

Signed and sworn to, before me at………………………………………………………….

On this………day of…………….…………………20……… by the Deponent(s), who

acknowledged that he/she/they know(s) and understand(s) the contents of this

document, that it is true and correct to the best of his/her/their knowledge and that

he/she/they have no objection to taking the prescribed oath, and that the prescribed

oath will be binding on his/her/their conscience.

Signature and Official stamp: …………………………………………

NOTE: ALL PAGES OF THIS DOCUMENT MUST BE INITIALED BY THE DEPONENT AS WELL

AS THE COMMISSIONER OF OATHS.

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ANNEXURE A INFORMATION AND GUIDELINES FOR COMPLETING AND SUBMITTING THE UMSHWATHI MUNICIPALITY DATA BASE LISTING APPLICATION FORM

Completion of Questions: Please use a black pen and complete form in block letters.

Complete all fields. If a field is not applicable to your business or situation clearly mark it as “Not Applicable” or “N/A.” Clearly state YES/NO by circling your choice or N/A to questions asked. Do not leave any fields blank as this may result in the rejection of your application.

Signatures: Please ensure that the form is signed by an authorised person(s) and

that the signatories as well as the Commissioner of Oaths initial all pages.

Owners, Shareholders and Partners: Please ensure that the percentages of

ownership, amount to 100% and that every field is completed for each of the business owners.

Declaration of Correctness: Please ensure that the Declaration of Correctness

(Section 9) is signed and dated once all required documents and information have been submitted.

Processing of registration: Your completed registration will be processed and,

following verification and approval, you will be issued with a Supplier Database Registration Code to be used in all future communication with uMshwathi Municipality. This letter of verification will be dispatched to the correspondence details supplied by you on the application form.

Business Opportunities: Please note that registration on the uMshwathi

Municipality Supplier Database does not guarantee business opportunities. All procurement will be subjected to the SCM Policy of the UMshwathi Municipality.

Amendments or changes: Please notify the uMshwathi Municipality Supply Chain

Management (SCM) immediately of any changes to the information submitted.

Multiple offices: If a company has more than one office, each office must fill in a

separate form, unless the point of transaction is centralised in the company’s head office.

Commodity classification: Please note that the key facilities in the database are

classified as commodities and each potential supplier must indicate the commodities in which it would like to register for Request for Quotations (Please refer to Section 4)

Taxes: It’s a condition of bidding or tendering for the delivery of goods and services that

a provider’s taxes must be in order, or satisfactory arrangements must have been made with the South African Receiver of Revenue to meet his/her tax obligations. In bids where partnerships/consortia/joint ventures/sub - contractors are involved, each party must submit a separate Tax Clearance Certificate.

Municipal obligations: No listing will take place if a provider is not in good standing in

as far as his/her tax and municipal service obligations (e.g. water, electricity, etc.) are concerned.

Proof of Disability has to be submitted and can be obtained from: Department of Social

Welfare – Disability Grant registration; Medical Assessment report.

Required documentation: Please ensure that all copies of mandatory documents

(certified copies, where applicable) are attached. Failure to submit requested documentation may result in the rejection of the application. The onus is on the applicant to ensure that all such documentation is submitted and certified where necessary and the Municipality is under no obligation nor does it accept responsibility for contacting applicants in any way should all required documents not be attached.

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All or some of the following documentation may be relevant to your application:

Certified company registration documents (including CK1 and CK2) Certified identity documents of directors, owners, partners, members or

shareholder Certified proof of shareholding documents (shareholder certificates or share

allocation documents for CC members) if claiming HDI points. Valid original tax clearance certificate. Proof of banking document / cancelled cheque. Partnership agreements in the case of partnerships – certified Certificate of incorporation if Public Company (CM3) – certified Trust agreement, trustee details and letter of authority in the case of business

trust – certified Certificate of Incorporation (Section 21 Company) – certified Proof of Disability Value Added Tax (VAT) Registration Certificate (if applicable) Compensation of Occupational Injuries and Diseases (COID) Registration

Certificate Any other relevant registration certificate pertaining to your business,

e.g. NHBRC, SAACE, etcetera. Proof of Municipality Levy Registration Certified copy of BBBEE rating certificate Company profile

Copies of Documents: Please keep copies of the registration form and all supporting documentation submitted, for your own records and to ensure that all data is maintained and up to date on a continual basis.

Return of documents: Documents submitted to the Municipality in support of this application will not be returned if an application is unsuccessful or under any other circumstances.

Please consult attached schedule.

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DOCUMENTS REQUIRED DOCUMENTS REQUIRED

Sole Proprietor

CC’s and Private Companies

Partnerships Public Company

Business Trust

Non-Profit Organization (NPO)

Where to get documents

COMPANY REGISTRATION CERTIFICATE COPIES

N/A Certificate of Incorporation CK1/ CK2

Partnership agreement

Certificate of Incorporation CM3

Trust agreement Certificate of Incorporation Section 21

Registrar of CC’s & Companies

PROOF OF OWNERSHIP CERTIFICATE COPIES

N/A Shareholding CK1/ CK2

Partnership agreement

Shareholding CM3

Trustees details: Letter of Authority

Auditor’s letter – no shareholding

Registrar of CC’s & Companies

PROOF OF BANKING

Bank statement/ Cancelled cheque






Branch of bank where account is

TAX CLEARANCE CERTIFICATE

For the owner or the business

For the company/ CC

For each individual shareholder

For the company

For the trust For the NPO SARS

P.A.Y.E If staff are employed

If staff are employed




If staff are employed SARS

VAT REGISTRATION

Yes Yes Yes Yes Yes Yes SARS

U.I.F. Certificate Yes Yes, if staff remunerated

Yes, if staff remunerated




Department of Labour

Workman’s Compensation







Department of Labour

Security Officer’s Board

If applicable for security industry






Security Service Regulatory Authority

Proof of Disability

If owner is disabled

If shareholder is disabled





Department of Social Welfare Disability Grant Registration

Proof of Identity CERTIFIED

Owner Directors/ Members

Partners Directors Trustees Directors

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DECLARATION OF INTEREST

1. No bid will be accepted from persons in the service of the state¹.

2. Any person, having a kinship with persons in the service of the state, including a blood relationship, may make an offer or offers in terms of this invitation to bid. In view of possible allegations of favouritism, should the resulting bid, or part thereof, be awarded to persons connected with or related to persons in service of the state, it is required that the bidder or their authorised representative declare their position in relation to the evaluating/adjudicating authority.

3 In order to give effect to the above, the following questionnaire must be completed and submitted with the bid.

3.1. Full Name of bidder or his or her representative: …………………………………………………………….

3.2. Identity Number: …………………………………………………………………………………………………

3.3. Position occupied in the Company (director, trustee, hareholder²):……………………….. ……………..

3.4. Company Registration Number: ……………………………………………………………………………….

3.5. Tax Reference Number:………………………………………………………………………………………..

3.6. VAT Registration Number: …………………………………………………………………………………..

3.7. The names of all directors / trustees / shareholders members, their individual identity

numbers and state employee numbers must be indicated in paragraph 4 below.

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3.8 Are you presently in the service of the state? YES / NO

3.8.1 If yes, furnish particulars. ….…………………………………………………………………………..

…………………………………………………………………………………………………………….

¹MSCM Regulations: “in the service of the state” means to be –

(a) a member of – (i) any municipal council; (ii) any provincial legislature; or (iii) the national Assembly or the national Council of provinces;

(b) a member of the board of directors of any municipal entity; (c) an official of any municipality or municipal entity; (d) an employee of any national or provincial department, national or provincial public entity or constitutional institution within the

meaning of the Public Finance Management Act, 1999 (Act No.1 of 1999); (e) a member of the accounting authority of any national or provincial public entity; or (f) an employee of Parliament or a provincial legislature.

² Shareholder” means a person who owns shares in the company and is actively involved in the management of the company or business and exercises control over the company.

3.9 Have you been in the service of the state for the past twelve months? ………YES / NO

3.9.1 If yes, furnish particulars.………………………...…………………………………….. …………….

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……………………………………………………………………………………………. …………….

3.10 Do you have any relationship (family, friend, other) with persons

in the service of the state and who may be involved with

the evaluation and or adjudication of this bid? ………………………………… YES / NO

3.10.1 If yes, furnish particulars.

…………………………………………………………………………………………………………

…………………………………………………………………………………………………………

3.11 Are you, aware of any relationship (family, friend, other) between

any other bidder and any persons in the service of the state who

may be involved with the evaluation and or adjudication of this bid? YES / NO

3.11.1 If yes, furnish particulars

…………………………………………………………………………………………………………

……………………………….……..............................................................................................

3.12 Are any of the company’s directors, trustees, managers,

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principle shareholders or stakeholders in service of the state? YES / NO


…………………………………………………………………………………………………………...

…………………………………………………………………………………………………………...

3.13 Are any spouse, child or parent of the company’s directors

trustees, managers, principle shareholders or stakeholders

in service of the state? YES / NO


………………………………………………………………………………………………………….

………………………………………………………………………………………………………….

3.14 Do you or any of the directors, trustees, managers,

principle shareholders, or stakeholders of this company have any interest in any other related companies or business whether or not they are bidding for this contract. YES / NO

3.14.1 If yes, furnish particulars:

………………………………………………………………………………………………………… …………………………………………………………………………………………………………

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4. Full details of directors / trustees / members / shareholders.

Full Name Identity Number State Employee Number

………………………………….. ……………………………………..

Signature Date

…………………………………. ………………………………………

Capacity Name of Bidder

uMshwathi MUNICIPALITY · 2016-10-11 · 00205 Demolition services 00424 Locksmith services 00206...

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Transcript of uMshwathi MUNICIPALITY · 2016-10-11 · 00205 Demolition services 00424 Locksmith services 00206...